二甲双胍治疗多囊卵巢综合征对改善内分泌、排卵功能、妊娠的疗效

Effect of metformin on improving hormones,ovulation function and pregnancy in women with polycystic ovary syndrome

目的:探讨二甲双胍对胰岛素存在拮抗的多囊卵巢综合征(Polycystic ovary syndrome,PCOS)患者促排卵治疗以及提高妊娠率的效果。方法:选择存在胰岛素拮抗的耐克罗米酚的PCOS患者78例,口服二甲双胍治疗,3个月后,未恢复正常月经者联合克罗米酚促排卵,治疗前或治疗后每隔3个月分别测量身高、体重、卵巢体积、空腹胰岛素、服糖后2 h胰岛素、空腹血糖、服糖后2 h血糖、睾酮(T)、性激素结合蛋白(SHBG)、促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)。结果:经3个月治疗,治疗前后相比,血糖水平无改变,体重指数有下降,但无显著差异(P>0.05);卵巢体积由(16.3±1.5)mm2下降至(8.3±2.1)mm2,差异有显著性(P<0.01);空腹胰岛素及服糖后胰岛素有明显下降(P<0.01),LH和LH/FSH有明显下降(P<0.05),SHBG显著上升(P<0.01),FSH、E2无改变。经3个月治疗效果不显著者13例,延长二甲双胍的用药时间和增加剂量后,胰岛素显著下降(P<0.01)。成熟卵泡发育74例(94.8%),排卵65例(85.5%),妊娠31例(39.8%)。结论:二甲双胍能有效地改善胰岛素拮抗,提高排卵率和妊娠成功率,部分病人延长治疗时间和增加剂量能取得更好的效果。

Objective： To evaluate the mefformin efficacy of ovulation and increasing pregnancy rate in polycystic ovary syndrome （PCOS） patients with insulin resistance （IR） . Methods： 78 PCOS patients with IR and anti -clomiphene were treated with mefformin by month orally. The combined clomiphene therapy was given to those had no recovery from menstrual after three months, in order to stimulate ovulation. Height, ovary volume, fasting and after meal insulin, fasting and after meal blood glucose, testosterone （T）, sex -hormone binding globulin （SHBG）, follicle- stimulating hormone （FSH）, luteotrop （h） ic hormone （LH）, estradiol （E2 ） were detected before and after the treatment every three months respectively. Results： The findings of the detection after treatment were compared with those results before the treatment. The level of blood glucose, FSH and E2 had no markedly change. Weight index was descended but no significance （ P 〉0. 05 ） . Ovary volume was decreased from （ 16. 3 ± 1.5 ） mm^3 to （ 8.3 ± 2. 1 ）mm^3, fasting and after glucose insulin, LH and IH/FSH together with SHBG were obviously increased, the difference were quite significantly （ P 〈 0. 01, P 〈 0. 01, P 〈 0. 05, P 〈 0. 01, respectively）. Therapeutic effectiveness was not obvious in 13 cases throughout the three- month treatment. Insulin was obviously decreased （P 〈 0. 01 ） after different dose of mefformin were given at a prolonged time to these 13 cases. Final results with mature follicles were developed in 74 cases （94. 80% ）, successful ovulation in 65 cases and pregnancy in 31 cases （39. 80% ） . Conclusion： Mefformin may effectively improve IR, and successfully increase the ovulation rate as well as the pregnancy rate. The efficacy is better if the increased dose of mefformin is given at prolonged time to some patients.